Being Mortal, by Atul Gawande has been floating around our house for sometime now. I'm not exactly sure what made me pick it up this week, but I'm glad I did. Gawande's book is about what matters at the end of our lives. He weaves together the stories of different people, both young and old, and of how each one is affected by their end of life decisions, or lack of decision they have each made. His own father's story is included.
As we age, we seem to be willing to accept more and more medical intervention, but sometimes that may not be the best course of action. If quantity is all you're after, then yes, let the medical establishment have their way, but when we are informed, and I mean truly informed, of what end of life might look like, a different course of action might be the better course. Gawande explains how difficult it can be for doctors to give you the full scope of what you might face. They want to give you the facts and let you chose. However, through his research and own experience he recommends the following questions be asked:
What is your understanding of where you are and of your illness?
Your fears or worries for the future
Your goals and priorities
What outcomes are unacceptable to you? What are you willing to sacrifice and not?
And later, what would a good day look like?
My parents entered an assisted living facility when my mom's needs due to her RA became too much for my father to handle alone. They had their own apartment, could set their own schedule, and set up a home. It was perfect for them. When my mother died, my father stayed on to the end of his life. Thankfully, the thought of a nursing home never had to be addressed. Gawande speaks to the difference between assisted living and nursing homes, and why people respond better when they feel as if they have a home and can set their own schedules, as these are quality of life issues.
Hospice is discussed here as well. One of my friends, a nurse practitioner, died twelve years ago from a squamous cell cancer. When she realized she couldn't beat it, she and her family asked hospice to come in. I had never seen hospice in action. They were amazing. When we had to call hospice in for my mom, again, amazing. Gawande discusses what hospice does and how many patients end up living longer than expected once their pain and anxiety needs have been addressed and met. They also tend to have a better quality of life, even if the long tail is shortened by a few months.
This is a book we all need. None of us live forever. Whether we are facing life's end, or even just starting out on our own, we will all be faced with questions about our own mortality or that of our loved ones. Information is a powerful tool for living a full and realized life. Dr. Atul Gawande addresses very well what being mortal is all about.
There are many more life end questions, besides the one's listed above, as well as other items we should take care of, like a will, a living will, as well as quality of life issues. Life is short and can be over before we are ready, so it's never too early to take care of these items.
Peace and Joy my friends!